Safe neoadjuvant trastuzumab-based treatment in HER2 + inflammatory early breast cancer in a glucose 6-phosphate dehydrogenase-deficient postmenopausal woman: A case report and review of the literature

• Published in: Journal of oncology pharmacy practice 2020-03, Vol.26 (2), p.492-495
• Main Authors: Cunquero-Tomás, Alberto J, Ávila-Andrade, Claudio D, Milara, Javier, Javier, Karla, Iranzo, Vega, Camps, Carlos
• Format: Article
• Language: English
• Subjects: Aged; Anthracycline; Antineoplastic Agents, Immunological - administration & dosage; Antioxidants; Blood transfusion; Breast cancer; Breast Neoplasms - complications; Breast Neoplasms - diagnosis; Breast Neoplasms - drug therapy; Breast Neoplasms - genetics; Carboplatin; Case reports; Chemotherapy; Dehydrogenases; ErbB-2 protein; Erythrocytes; Female; Glucosephosphate dehydrogenase; Glucosephosphate Dehydrogenase Deficiency - complications; Glucosephosphate Dehydrogenase Deficiency - diagnosis; Glucosephosphate Dehydrogenase Deficiency - drug therapy; Humans; Immunotherapy; Inflammation; Literature reviews; Monoclonal antibodies; Neoadjuvant Therapy - methods; Oxidative stress; Point mutation; Post-menopause; Postmenopause - drug effects; Postmenopause - genetics; Receptor, ErbB-2 - genetics; Targeted cancer therapy; Trastuzumab; Trastuzumab - administration & dosage; Treatment Outcome; Tumors
• ISSN: 1078-1552; 1477-092X
• DOI: 10.1177/1078155219858173

Introduction Glucose 6-phosphate dehydrogenase (G6PD) is a basic antioxidant pathway for erythrocytes, being its deficiency the most common gene mutation worldwide. As breast cancer is one of the most frequent tumors, many of these patients may present with G6PD deficiency prior treatment without notice. Case report We present the case of a woman deficient for G6PD with the diagnosis of Stage IIIB (cT4d cN1 cM0) HER2-enriched early breast cancer. Management and outcome The patient underwent neoadjuvance with trastuzumab and anthracycline-free chemotherapy, based on docetaxel (75 mg/m2, 120 mg) and carboplatin (AUC 5, 560 mg). She did not present hemolytic crisis and no blood transfusions were needed. She achieved a good pathologic response and completed one-year adjuvant trastuzumab without incidences. Discussion Although the role of HER2 and trastuzumab in oxidative stress is not yet completely understood, we suggest that trastuzumab may be a suitable agent for treatment in patients with HER2-enriched breast cancer in a non-oxidative chemotherapy scheme, with acceptable responses and no triggering hemolytic crisis.